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題名 | Effects of Dobutamine, Norepinephrine and Epinephrine on Intramucosal pH and Hemodynamics of Dogs during Endotoxic Shock=Dobutamine, Norepinephrine及Epinephrine對內毒素引發敗血性休克之狗之胃黏膜內酸鹼值及血流動力學之作用 |
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作者 | Hayes,John K.; Luo,Xia; Wong,K. C.; McJames,Scott; Tseng,Chin Kai; |
期刊 | 麻醉學雜誌 |
出版日期 | 19980900 |
卷期 | 36:3 1998.09[民87.09] |
頁次 | 頁113-126 |
分類號 | 414.5 |
語文 | eng |
關鍵詞 | 內毒素; 敗血性休克; 狗; 胃黏膜內酸鹼值; 血流動力學; Shock; Endotoxin; Catecholamines; Dobutamine; Epinephrine; Norepinephrine; pH; Intramucosal pH; pHi; Tonometry; |
英文摘要 | This study assessed the effects of dobutamine (DOB), epinephrine (EPI) and norepinephrine (NE) on gastric tissue oxygenation indicated by gastric intramucosal pH (pHi) and hemodynamics in dogs subjected to endotoxic shock. Twenty-four dogs were assigned to four groups of 6 dogs each: endotoxin without catecholamine and endotoxin with DOB, or EPI or NE. Endotoxic shock was induced by intravenous injection of 3 mg/kg of E. coli over 1 min, with an additional 3 mg/kg over the next 2 hrs. Dogs were resuscitated with normal saline to maintain pulmonary capillary wedge pressure(PCWP) near baseline levels.Catecholamines were infused at 0.1, 0.4 and 1.6μg/kg/min (EPI and NE) and 2.5, 5.0 and 10.0μg/kg/min (DOB) for 30 min at each rate. After 2hrs of endotoxemia, mean arterial pressure (MAP) and cardiac index (CI) and oxygenation delivery index (DO□I) for all dogs decreased by 46.5%, 43.9% and 15.1% respectively, while pHi decreased from 7.47 to 7.10. Endotoxemia increased blood lactate by 142%. Following fluid resuscitation, EPI( 1.6μg/kg/min) further increased lactate by 178% (1.22 to 3.4 mmol/L). No correlation was found between tonometry pHi and lactate (R□=0.003), pHi and pHa (R□=0.231), pHi and DO□I (R□=0.056) nor between intramucosal PCO□ and PaCO□(R□=0.005). pHi did not reflect the improvements in cardiovascular hemodynamics observed following administration of catecholamines. NE improved MAP, CI and DO□I whereas DOB produced similar effects as NE but further reduced SVR. EPI produced similar effects as NE. DOB, NE and EPI further decreased pHi. EPI significantly (P<0.05) increased blood lactate levels more than DOB and NE. |
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